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HomeMy WebLinkAboutGW1-2021-03902_Well Construction - GW1_20210823 828-622-7241 p'1 f cab 1619 05;43p olBarwailarvveli Drilling W LL!P O>,Y>E( "ll . For)ntcmnfU ntY; s( 1 1.3�1&)Lf,oat(r,,a�etnr lnformotion: Plo ► i 1 y\, 1 — 14. moat •ra n fR f4 Well Cantraciof Name � \ 41 �- NC Well Cnnnaaart cRfCreation Atmru6d Qp1BR ING Company Nmm11 c TO OR p 2.Well Cotmtractionremit#: M i.lst atl rggdirnbla well r.»nsunmlan/b+faR.a(I.u,fflG CcarrNy,Sfaly,Ym�Iner:v,"r`•) R. 3.,Vydl i1'n(check well age)_ 17. •rote floe at• Water Su To pplY we": ,�anlcipaUPubltc IR, tn- Ur Agricuttutal C..t. R C,ecthmmw(IieatittScowingsupply) ,RResidential Water Supply(single) IL h IndustriallC,ommmiai EJRemwential waur Supply(shrand) la oul. tag L sMlia WKS ten tiara ma r+ IT)' ' d tYnn-N'atcr 3upply'YI ail: fk� A7m►irorin Retlavary u. InjceNan d: n. R Aquit�Reebat$e oGroundwatciRcmrdit[itm r►j{LpA ` �� atrnto Aquifer Storgp mtd fto(wer) D"llity -- AquifvTcat nsu mrwatct-Draina$c R. (' SuMiderim Contml T;aperitttetltal 1!eaimaiggy � ,��, t.OG �• , GCOthctlnai(Ckttsed Drop) �)taelx NTO Genthe mal Iittatin ti Rtxu )) in under iJ2! Rcrnarks) ; 16 / sa d C� ft. �f'f4 �'•f'1' t.date Wdi(aj C'nmpieted:� cJ^ Well IDt/ r Su.Well i.aeadnn- R. it. - _ FAMOY m;t(;fappl►2blt) r�eilit}:ain„cr taa,,,a . Physical Addresx,City,end lip ( y ' AP j [aunty Pnrcei fdacii4catinn Na \s: Fh.A.atitude ntrd(aap{Itnde to dagteeaJmimttes/secaads ar dccimnl drt;reas: '„2.Ce Cation: Drac (ii sw11 lucid,tunC tnLQttngfaflldlt61erd/ ����� i �tJ�/ � �- �(_ s tQe nrtkNtrrot Wd cafmcar 4.ls(are)the well Perrtraam of �7'emparary rlrtc'(n/aq I hfnr/W rrBXlJy iAar dir.mdl(�ucvrs{Harr)cotrarmetad In acMtda.7Gr I;V llynlrl$ 7.As this a repair to an ex(sttiag well: Dyes or No u pG 1St wr'A['02f•B1011 ar 19A rY(AC 42C..t1Tt10 Wi!tl Cmtsfrmilnn Yl Rarl r m rr "tldris"rvwr.011MrAwwnwell.AmrrnuJaaj++Mad(jao+/A"Plai"Ih.'alUGfl•AfIRB r"pus{ �n r'r`lp°�1r pent tntltewcf/mvtt+r. r+mtr render n;1 mmnntiz fcenan rta tfm tmceottritst++mr. ;L Slto 4wgrrzam or addidwid We11 damlm: 1'ou may use file back of this page to provide addiGolmi wa site doltalls ten well S.For Geoprabe/IiPT or Citwed-A.anp GeW6erttaai Wclta hawing fio snene cj)n9�inn tjefails. You nW also a mb additi met pages Ifnotxs®ary. +xtnWntctien,onh I CW-t is heeded fndicato T07AL NUMBER e,r—lis t ��('� (At.) 6or at1 Wsllu Submit this form v+rMn 30 days of completion of.veil I ilotat—11dep*inlaw land Sntfltcct,,.-.._��•.-a� ---- larrnnlNplrsvrltel:uadudepNutfd�ertxt(esampla-3(r1r1R(►oadi�!(dl'I can xitsntRtltcfallo►staB: _T� ft Division at;Water tilt Mrem,Inkrnnadon Precwft Ulfil, l0.gtttG e.vaeer levsl betaty top of mainge ( ) 1619 Walt SOrVkc Center,Ral4l9k PiC274"-1611 ,J•nYrnlr rB»:l rr rrhire cnrtag+nc••- (� (jn,) 2•it5,"__��r..a•Han Weila: 1n addition to settdittg flit:tbria die allmn in 24a 11,ilonettotrdlameter: move.Slaw submit one:copy of this form within 30 days�aDQlpltlltRt Of ArE1t m I?-%Vets constmence method: - a xn1matian to the fbilrAft (ic,nnaG-,mmp•.cablo,Aira•tinuaG,ata} Dlvlsiort t►fVYalsr(te:p►urlxs,UndargAound lglectton Cotthral Program. 1 fat mail ter Ace Center,llatelo.14C 2709-i636 POR WATER lCt-M V WELLS ONLY' t ibietliotl of te3h ?dC 1?nr Wil+r Qneals �OfaQill/[t�Nl11Ee: In addilien M tan t Iha tbmt to 13a.Yield(dpnn) - the addrgWO) aWvq also submit one copy of this form widlin 30 days of wmpletiort of vvdl consunwaaa to the county health depart of the county fib.Utsinfeetian tYlm^ .Amount: wtx+re oonatereeee. Irnrm C,1iu-1 NottL(�uniium t)apmm�ont at'iinvlydnnu�tat Q7dlty-1Nvis�an of UVatar Rmmneav RWmad2 22 2nib